# Efficacy and Safety of Fundoplication Sleeve Gastrectomy in Obesity and GERD: A Systematic Review and Meta-Analysis

## TL;DR

This study compares fundoplication sleeve gastrectomy (FSG) and sleeve gastrectomy (SG) for obesity, finding similar weight loss but fewer GERD cases with FSG, though it has higher complication risks.

## Contribution

The study introduces a systematic review and meta-analysis comparing FSG and SG, highlighting FSG's potential to reduce GERD while acknowledging increased surgical risks.

## Key findings

- FSG and SG showed similar excess weight loss outcomes.
- FSG significantly reduced postoperative GERD prevalence compared to SG.
- FSG had higher complication and reoperation rates than SG.

## Abstract

Background/Objectives: Laparoscopic sleeve gastrectomy (SG) is the most performed bariatric procedure, providing effective weight loss and comorbidity improvement. However, its association with new-onset or worsening gastroesophageal reflux disease (GERD) remains a limitation. To address this, fundoplication sleeve gastrectomy (FSG) has been proposed by combining SG with an anti-reflux procedure. This systematic review and meta-analysis evaluates the efficacy and safety of FSG in patients with severe obesity. Methods: PubMed, Scopus, and Web of Science were systematically searched up to December 2023. Eligible studies included adults with BMI ≥ 40 kg/m2 or ≥35 kg/m2 with comorbidities undergoing FSG or SG with ≥12 months of follow-up. Random-effects meta-analysis compared FSG and SG in terms of weight loss, postoperative GERD, and complications. Results: Twelve studies (n = 543) were included; five contributed to the meta-analysis. Pooled analysis showed no significant difference in percentage of excess weight loss (%EWL) between FSG and SG (Hedges’ g = −0.11; 95% CI: −0.99–0.76; I2 = 86%), and similar %TWL outcomes (Hedges’ g = −0.28; 95% CI: −0.70–0.13). FSG demonstrated a significantly lower postoperative GERD prevalence (RR = 0.08; 95% CI: 0.01–0.47) and greater GERD resolution (RR = 1.86; 95% CI: 0.80–4.20), but higher complication (RR = 2.95; 95% CI: 1.02–8.50) and reoperation rates (RR = 4.39; 95% CI: 1.47–13.12). Conclusions: FSG achieves weight loss comparable to SG and may reduce postoperative GERD prevalence, but carries an increased complication and reoperation risk. Further randomized trials with standardized GERD definitions and longer follow-up are required.